Healthcare Provider Details

I. General information

NPI: 1093761116
Provider Name (Legal Business Name): MONICA P MEDINA MCCURDY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 N 23RD ST
PHILADELPHIA PA
19121-2055
US

IV. Provider business mailing address

2144 CECIL B MOORE AVE
PHILADELPHIA PA
19121-4014
US

V. Phone/Fax

Practice location:
  • Phone: 215-235-3110
  • Fax: 215-235-4441
Mailing address:
  • Phone: 215-320-6187
  • Fax: 215-235-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA051067
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: